Disproportionate Burden of COVID-19 Infection Among Hispanic Patients During the First COVID-19 Surge in South Texas.

Introduction: The morbidity and mortality of the COVID-19 pandemic have disproportionately burdened Hispanic populations in the United States. While health equity research is typically conducted in populations where Hispanics are the minority, this project analyzes COVID-19 racioethnic transmission trends over the first 6 months of the pandemic within a large majority-minority city in South Texas. Methods: Patients diagnosed with COVID-19 across inpatient, emergency department, and outpatient settings of a large county health system were included in a clinical registry. For 4644 COVID-19-positive patients between March 16 and August 31, 2020, demographic and clinical data were abstracted from the registry. Race/ethnicity trends over time were compared for patients with and without COVID-19 diagnoses. Logistic regressions identified predictors of inpatient diagnosis by age, race/ethnicity, and testing delay. Results: The proportion of patients with COVID-19 identifying as Hispanic increased rapidly during the pandemic's first months: from 55.6% in March to 85.7% in June. A significantly greater proportion of patients identified as Hispanic within the COVID-19 cohort compared to other diagnoses cohort. Testing delay was 11.6% longer for Hispanic patients, with each day of testing delay associated with 7% increased odds of inpatient COVID-19 diagnosis. Conclusion: These findings highlight the disproportionate impact of COVID-19 on Hispanic populations even within a majority-minority community. In the United States, Hispanic persons are more likely to work frontline jobs, live in multigenerational homes in poverty, and be uninsured. The burden of COVID-19 cases within Bexar County's largest hospital system reflects this systemic inequity. Identifying racioethnic health disparities supports efforts toward mitigating structural factors that predispose minority groups to illness and death.

Growth inhibition of pathogenic microorganisms by Pseudomonas protegens EMM-1 and partial characterization of inhibitory substances.

The bacterial strain, EMM-1, was isolated from the rhizosphere of red maize ("Rojo Criollo") and identified as Pseudomonas protegens EMM-1 based on phylogenetic analysis of 16S rDNA, rpoB, rpoD, and gyrB gene sequences. We uncovered genes involved in the production of antimicrobial compounds like 2,4-diacetylphloroglucinol (2,4-DAPG), pyoluteorin, and lectin-like bacteriocins. These antimicrobial compounds are also produced by other fluorescent pseudomonads alike P. protegens. Double-layer agar assay showed that P. protegens EMM-1 inhibited the growth of several multidrug-resistant (MDR) bacteria, especially clinical isolates of the genera Klebsiella and ß-hemolytic Streptococcus. This strain also displayed inhibitory effects against diverse fungi, such as Aspergillus, Botrytis, and Fusarium. Besides, a crude extract of inhibitory substances secreted into agar was obtained after the cold-leaching process, and physicochemical characterization was performed. The partially purified inhibitory substances produced by P. protegens EMM-1 inhibited the growth of Streptococcus sp. and Microbacterium sp., but no inhibitory effect was noted for other bacterial or fungal strains. The molecular weight determined after ultrafiltration was between 3 and 10 kDa. The inhibitory activity was thermally stable up to 60°C (but completely lost at 100°C), and the inhibitory activity remained active in a wide pH range (from 3 to 9). After treatment with a protease from Bacillus licheniformis, the inhibitory activity was decreased by 90%, suggesting the presence of proteic natural compounds. All these findings suggested that P. protegens EMM-1 is a potential source of antimicrobials to be used against pathogens for humans and plants.

Implementation of Universal Tumor Screening of Colorectal Cancer for Detection of Lynch Syndrome at a Hispanic-Rich County Hospital.

INTRODUCTION: In 2014, a reflexive screening protocol for Lynch syndrome (LS) via an immunohistochemistry (IHC) assay was shown to be cost-effective; however, the screening rates at a predominant Hispanic-rich institution are unclear. We hypothesized that implementation of a universal tumor screening (UTS) protocol requiring screening for LS via IHC in patients with newly diagnosed colorectal cancer (CRC) at our Hispanic-rich institution would improve detection of LS by increasing screening rates. METHODS AND MATERIALS: This is a retrospective analysis of screening rates of 3 sequential cohorts of newly diagnosed patients with CRC between January 2012 and April 2016 at the University Health System and with follow-up at National Cancer Institute-designated Mays Cancer Center at University of Texas Health San Antonio. Cohort 1 consisted of patients screened using old screening guidelines (PRE). Cohort 2 consisted of patients screened when treating clinicians were receiving education on the new protocol (PERI). Cohort 3 consisted of patients screened after implementation of the UTS protocol (POST). RESULTS: The majority of 312 patients were Hispanic (62.5%), 18.1% were < 50 years, and 81.9% were ≥ 50 years of age (median age, 57 years). Of patients with CRC screened for LS via IHC, the PRE, PERI, and POST cohorts had screening rates of 31%, 64%, and 58%, respectively. We found significant differences when comparing the PRE with POST sequential cohorts (P < .01). CONCLUSION: The quality of Lynch syndrome-related family histories and screening rates were significantly improved after implementation in our Hispanic-rich population. Future studies are warranted to provide insight into clinical effects of increased screening, provider and patient surveillance, and screening-related systemic barriers.

Cardiovascular Risk Assessment Varies Widely by Calculator and Race/Ethnicity in a Majority Latinx Cohort Living with HIV.

Comparison of cardiovascular disease (CVD) risk calculators in Latinx majority populations living with HIV can assist clinicians in selecting a calculator and interpreting results. 10-year CVD risks were estimated for 652 patients seen ≥ 2 times over 12 months in a public clinic using three risk calculators: Atherosclerotic CVD risk Calculator (ASCVD), Framingham Risk Calculator (FRC), and Data Collection on Adverse Effects of Anti-HIV Drugs Study (D:A:D) Calculator. Median estimated 10-year CVD risk in this population was highest using FRC (11%), followed by D:A:D (10%), and lowest with ASCVD (5%; p < 0.001). However, D:A:D classified 44.3% in a high/very high risk category compared to FRC (20.7%) and ASCVD (33.4%) (all p < 0.001). ASCVD risk estimates differed significantly by race/ethnicity (p < 0.001). Risk varied widely across three risk calculators and by race/ethnicity, and providers should be aware of these differences when choosing a calculator for use in majority minority populations.

Patient Perception and Cost-Effectiveness of a Patient Navigation Program to Improve Breast Cancer Screening for Hispanic Women.

Purpose: Hispanic women are less likely to be screened for breast cancer than non-Hispanic women, which contributes to the disproportionate prevalence of advanced-stage breast cancer in this population group. Patient navigation may be a promising approach to help women overcome the complexity of accessing multiple health care services related to breast cancer screening and treatment. The goal of this study is to assess patient perception and cost-effectiveness of a multilevel, community-based patient navigation program to improve breast cancer screening among Hispanic women in South Texas. Methods: We used mixed methods-including focus groups of program participants and a microsimulation model of breast cancer-to evaluate the effectiveness and cost-effectiveness of the program on the target population. Program data from 2013 to 2016 were collected and used to conduct the analyses. Results: Focus groups showed that the patient navigation program improved patient knowledge, attitudes, and behaviors regarding breast health and increased the mammography screening rate from 60% to 80%. Cost-effectiveness analysis showed that the program could increase life expectancy by 0.71 years and yield an incremental cost-effectiveness ratio of $3120 per quality-adjusted life year compared to no intervention. Conclusion: The 3-year multilevel, community-based patient navigation program effectively increased mammography screening uptake and adherence and improved knowledge and behaviors on breast health among program participants. Future research is needed to translate and disseminate the program to other socioeconomic and demographic groups to test its robustness and design.

Improving HIV Care Engagement in the South from the Patient and Provider Perspective: The Role of Stigma, Social Support, and Shared Decision-Making.

Initial linkage to medical care is a critical step in the HIV care continuum leading to improved health outcomes, reduced morbidity and mortality, and decreased HIV transmission risk. We explored differences in perspectives on engagement in HIV care between people living with HIV who attended (Arrived) their initial medical provider visit (IMV) and those who did not (Missed), and between patients and providers. The study was conducted in two large majority/minority HIV treatment centers in the United States (US) south, a geographical region disproportionately impacted by HIV. The Theory of Planned Behavior informed semistructured interviews eliciting facilitators and barriers to engagement in care from 53 participants: 40 patients in a structured sample of 20 Missed and 20 Arrived, and 13 care providers. Using Grounded Theory to frame analysis, we found similar perspectives for all groups, including beliefs in the following: patients' control over care engagement, a lack of knowledge regarding HIV within the community, and the impact of structural barriers to HIV care such as paperwork, transportation, housing, and substance use treatment. Differences were noted by care engagement status. Missed described HIV-related discrimination, depression, and lack of social support. Arrived worried what others think about their HIV status. Providers focused on structural barriers and process, while patients focused on relational aspects of HIV care and personal connection with clinics. Participants proposed peer navigation and increased contact from clinics as interventions to reduce missed IMV. Context-appropriate interventions informed by these perspectives are needed to address the expanding southern HIV epidemic.

Prescription Opioid Use is Associated with Virologic Failure in People Living with HIV.

Prescription opioid misuse is a rising epidemic in the U.S., and people living with HIV are at increased risk. We assessed the association between prescription opioid use and virologic failure in HIV+ patients in the South Texas HIV Cohort. We found prescription opioid use was significantly associated with virologic failure, after adjustment for age, race, gender, insurance status, years living with HIV, reported HIV risk factor, chronic hepatitis C virus infection, current substance abuse, and care engagement. These findings suggest that opioid analgesic use may have negative consequences beyond misuse in people living with HIV.

Cost-effectiveness of a patient navigation program to improve cervical cancer screening.

OBJECTIVES: To assess the cost-effectiveness of a community-based patient navigation program to improve cervical cancer screening among Hispanic women 18 or older in San Antonio, Texas. STUDY DESIGN: We used a microsimulation model of cervical cancer to project the long-term cost-effectiveness of a community-based patient navigation program compared with current practice. METHODS: We used program data from 2012 to 2015 and published data from the existing literature as model input. Taking a societal perspective, we estimated the lifetime costs, life expectancy, and quality-adjusted life-years and conducted 2-way sensitivity analyses to account for parameter uncertainty. RESULTS: The patient navigation program resulted in a per-capita gain of 0.2 years of life expectancy. The program was highly cost-effective relative to no intervention (incremental cost-effectiveness ratio of $748). The program costs would have to increase up to 10 times from $311 for it not to be cost-effective. CONCLUSIONS: The 3-year community-based patient navigation program effectively increased cervical cancer screening uptake and adherence and improved the cost-effectiveness of the screening program for Hispanic women 18 years or older in San Antonio, Texas. Future research is needed to translate and disseminate the patient navigation program to other socioeconomic and demographic groups to test its robustness and design.

Medición de la calidad de vida mediante índices sintéticos en localidades del municipio de Acapulco, Guerrero, México

Objetivo:en este trabajo se contrastan diferentes índices sintéticos que buscan mejorar la aproximación a la medición de la percepción de la calidad de vida de las personas.Métodos:se levantó una muestra de 220 personas en dos comunidades suburbanas del municipio de Acapulco. Se realizó la reducción de variables con la técnica del Análisis de Componentes Principales; sobre ésta, se obtuvieron tres índices sintéticos (Suma, Global y DP2).Resultados:al comparar los resultados obtenidos con la percepción de la calidad de vida que los sujetos declararon, se puede concluir que el mejor acercamiento a dicha percepción lo hace el índice sintético DP2, al lograr el 39.1% de coincidencias directas fundamentalmente en las categorías de buena y muy buena calidad de vida.Conclusiones:estos resultados muestran que el 80.9% de los encuestados consideran que su calidad de vida está entre buena y muy buena, mientras que sólo el 35% se ubica en estas categorías utilizando el índice económico. Este hecho permite corroborar que, al menos en este caso, las condiciones económicas no definen totalmente la percepción de la calidad de vida de las personas encuestadas.

Objective:in this paper, we contrast different synthetic indexes that seek to improve the approach to measurement of the quality of life perceived by people.Methods:we took a sample of 220 people from different suburban communities from the municipality of Acapulco. Reduction of variables was done with the Principal Component Analysis technique; with it, we obtained three synthetic indexes (Sum, Global, ad DP2).Results:by comparing the obtained results, with the perception of the quality of life that people reported, we can conclude that the best approach to this perception is done by the synthetic index DP2, which achieves 39.1% of direct matches, especially, in the good and very good quality of life categories.Conclusions:these results show that 80.9% of survey respondents consider that their quality of life is between good and very good, while only 35% are located in these categories using the economic index. This fact allows us to corroborate that, at least in this case, the economic conditions do not define the survey respondents' perception of quality of life.

Missed Initial Medical Visits: Predictors, Timing, and Implications for Retention in HIV Care.

HIV disproportionately affects racial/ethnic minorities and individuals living in the southern United States, and missed clinic visits account for much of this disparity. We sought to evaluate: (1) predictors of missed initial HIV medical visits, (2) time to initial visit, and (3) the association between initial visit attendance and retention in HIV care. Chart reviews were conducted for 200 consecutive HIV-infected patients (100 in Dallas, 100 in San Antonio) completing case management (CM) intake. Of these, 52 (26%) missed their initial visit, with 22 (11%) never presenting for care. Mean age was 40 years, 85% were men, >70% were of minority race/ethnicity, and 28% had a new HIV diagnosis. Unemployment (OR [95% CI] = 2.33 [1.04-5.24], p = 0.04) and lower attendance of CM visits (OR = 3.08 [1.43-6.66], p = 0.004) were associated with missing the initial medical visit. A shorter time to visit completion was associated with CD4 ≤ 200 (HR 1.90 [1.25-2.88], p = 0.003), Dallas study site (HR = 1.48 [1.03-2.14], p = 0.04), and recent hospitalization (HR = 2.18 [1.38-3.43], p < 0.001). Patients who did not complete their initial medical visit within 90 days of intake were unlikely to engage in care. Initial medical visit attendance was associated with higher proportion of visits attended (p = 0.04) and fewer gaps in care (p = 0.01). Missed medical visits were common among HIV patients initiating or reinitiating care in Texas. Employment and CM involvement predicted initial medical visit attendance, which was associated with retention in care. New, early engagement strategies are needed to decrease missed visits and reduce HIV health disparities.

Hospital-Based Hepatitis C Screening of Baby Boomers in a Majority Hispanic South Texas Cohort: Successes and Barriers to Implementation.

OBJECTIVE: To comply with the 2012 CDC recommendations for hepatitis C virus (HCV) screening, we implemented a new HCV screening program for patients born between 1945 and 1965 at a South Texas safety-net hospital. METHODS: Patients with no HCV diagnosis or prior HCV test received an automated order for HCV antibody (anti-HCV) tests combined with reflex HCV ribonucleic acid (RNA) polymerase chain reaction. An inpatient counselor educated anti-HCV-positive patients. A bilingual patient navigator assisted newly diagnosed chronic HCV patients with linkage to primary and specialty care. We examined results for Hispanic vs. non-Hispanic patients in the first 10 months of project implementation in 2013-2014. RESULTS: Of 2,327 patients screened for HCV, the 192 (8%) patients who tested anti-HCV positive were younger than those who tested negative (56 vs. 58 years, respectively, p<0.001) and more likely to be male (p<0.001). Of the 167 anti-HCV-positive patients tested for HCV RNA, 108 (65%) were HCV RNA positive (5% of cohort). Barriers to care for HCV RNA-positive patients included a lack of health insurance, current substance abuse, incarceration, and homelessness. Hispanic HCV RNA-positive patients were more likely than non-Hispanic HCV RNA-positive patients to be substance abusers or incarcerated. Of all HCV RNA-positive patients, 103 patients (95%) received counseling, 94 patients (87%) were linked to primary care, 47 patients (44%) were linked to specialty care, and eight patients (7%) started treatment. CONCLUSION: The prevalence of anti-HCV-positive and chronically HCV-infected patients was higher than many Hispanic or non-Hispanic white cohorts. Most Hispanic patients newly diagnosed with chronic HCV had barriers to care for HCV infection that must be overcome if HCV screening is to reduce morbidity and mortality in this population.

High priority for hepatitis C screening in safety net hospitals: Results from a prospective cohort of 4582 hospitalized baby boomers.

UNLABELLED: Low-income populations are disproportionately affected by hepatitis C virus (HCV) infection. Thus, implementing baby boomer screening (born 1945-1965) for HCV may be a high priority for safety net hospitals. We report the prevalence and predictors of HCV infection and advanced fibrosis or cirrhosis based on the Fibrosis-4 score plus imaging for a baby boomer cohort admitted to a safety net hospital over a 21-month interval with >9 months of follow-up. Anti-HCV antibody testing was performed for 4582, or 90%, of all never-screened patients, of whom 312 (6.7%) tested positive. Adjusted odds ratios of testing anti-HCV-positive were 2.66 for men versus women (P<0.001), 1.25 for uninsured versus insured (P=0.06), 0.70 for Hispanics versus non-Hispanic whites (P=0.005), and 0.93 per year of age (P<0.001). Among 287 patients tested for HCV RNA (91% of all anti-HCV-positive cases), 175 (61%) were viremic (3.8% overall prevalence in cohort), which was 5% less likely per year of age (P<0.03). Noninvasive staging of 148 (84.6%) chronic HCV patients identified advanced fibrosis or cirrhosis in 50 (33.8%), with higher adjusted odds ratios of 3.21 for Hispanics versus non-Hispanic whites/Asians (P=0.02) and 1.18 per year of age (P=0.001). Other factors associated with significantly higher adjusted odds ratios of advanced fibrosis or cirrhosis were alcohol abuse/dependence, obesity, and being uninsured. CONCLUSION: In this low-income, hospitalized cohort, 4% of 4582 screened baby boomers were diagnosed with chronic HCV, nearly twice the rate in the community; one-third had noninvasive testing that indicated advanced fibrosis or cirrhosis, which was significantly more likely for Hispanics, those of older age, those with obesity, those with alcohol abuse/dependence, and those who lacked insurance.

Implementing hospital-based baby boomer hepatitis C virus screening and linkage to care: Strategies, results, and costs.

BACKGROUND/OBJECTIVE: The US Preventive Services Task Force recommends 1-time hepatitis C virus (HCV) screening of all baby boomers (born 1945-1965). However, little is known about optimal ways to implement HCV screening, counseling, and linkage to care. We developed strategies following approaches used for HIV to implement baby boomer HCV screening in a hospital setting and report results as well as costs. DESIGN/PATIENTS: Prospective cohort of 6140 baby boomers admitted to a safety-net hospital in South Texas from December 1, 2012 to January 31, 2014 and followed to December 10, 2014. PROCEDURES/MEASUREMENTS: The HCV screening program included clinician/staff education, electronic medical record algorithm for eligibility and order entry, opt-out consent, anti-HCV antibody test with reflex HCV RNA, personalized inpatient counseling, and outpatient case management. Outcomes were anti-HCV antibody-positive and HCV RNA-positive results. RESULTS: Of 3168 eligible patients, 240 (7.6%) were anti-HCV positive, which was more likely (P < 0.05) for younger age, men, and uninsured. Of 214 (89.2%) patients tested for HCV RNA, 134 (4.2% of all screened) were positive (chronic HCV). Among patients with chronic HCV, 129 (96.3%) were counseled, 108 (80.6%) received follow-up primary care, and 52 (38.8%) received hepatology care. Five patients initiated anti-HCV therapy. Total costs for start-up and implementation for 14 months were $286,482. CONCLUSIONS: This inpatient HCV screening program diagnosed chronic HCV infection in 4.2% of tested patients and linked >80% to follow-up care. Yet access to therapy is challenging for largely uninsured populations, and most programmatic costs of the program are not currently covered.

Cost-effectiveness analysis of a colonoscopy screening navigator program designed for Hispanic men.

Although Hispanic men are at higher risk of developing colon cancer compared to non-Hispanic white men, colonoscopy screening among Hispanic men is much lower than among non-Hispanic white men. University Health System (UHS) in San Antonio, Texas, instituted a Colorectal Cancer Male Navigation (CCMN) Program in 2011 specifically designed for Hispanic men. The CCMN Program contacted 461 Hispanic men 50 years of age and older to participate over a 2-year period. Of these age-eligible men, 370 were screened for CRC after being contacted by the navigator. Using participant and program data, a Markov model was constructed to determine the cost-effectiveness of the CCMN Program. An average 50-year-old Hispanic male who participates in the CCMN Program will have 0.3 more quality-adjusted life-years (QALYs) compared to a similar male receiving usual care. Life expectancy is also predicted to increase by 6 months for participants compared to non-participants. The program results in net health care savings of $1,148 per participant ($424,760 for the 370 CCMN Program participants). The incremental cost-effectiveness ratio is estimated at $3,765 per QALY in favor of the navigation program. Interventions to reduce disparities in CRC screening across ethnic groups are needed, and this is one of the first studies to evaluate the economic benefit of a patient navigator program specifically designed for an urban population of Hispanic men. A colorectal cancer screening intervention which relies on patient navigators trained to address the unique needs of the targeted population (language barriers, transportation and scheduling assistance, colon cancer, and screening knowledge) can substantially increase the likelihood of screening and improve quality of life in a cost-effective manner.

Increasing cervical cancer screening for a multiethnic population of women in South Texas.

Cervical cancer is a preventable disease. Precancers can be identified and treated through cervical screenings. The HPV vaccine prevents precancers from becoming cancers. The aim of the A Su Salud Cervical Cancer Prevention Program was to apply well-understood health promotion techniques and increase the rate of cervical cancer screening among a high-risk, multiethnic, low-income population in South Texas. Qualitative research was used to identify uptake barriers and tailor media messaging. Using existing resources, we applied evidence-based strategies in novel ways that changed personal behaviors, leading to cancer screening, risk reduction, and early detection. We created a database to track a cohort of 32,807 women and measured cervical cancer screenings over 3 years. Our analysis revealed an increase in cervical cancer screenings after use of highly targeted automated telephone reminders and media dissemination on multiple platforms. Those women at low risk for cervical cancer obtained the highest proportion of Pap tests. This innovative, theory-based program increased overall Pap tests up to 9% among women enrolled in a safety net hospital financial assistance plan. This study fills a gap in research on Pap test compliance in uninsured, mostly Hispanic women by building on cultural strengths and tailored messaging.

The ABCs of Health Literacy.

A significant portion of the US population has serious problems with both literacy and understanding how to effectively use and understand health-related information. An understanding of the breadth and significance of this problem and its impact on health outcomes is now clear. Interventions and strategies for effectively working with patients with limited literacy must be developed and evaluated. An agenda for medical and public health workers, health educators, and researchers is suggested.

A qualitative study of Mexican American adolescents and depression.

Depressive disorders are present in a high percentage of Mexican American adolescents. Among the US Mexican American population, suicide is the fourth leading cause of death among 10- to 19-year-olds. Little research, however, has focused on Mexican American adolescents' knowledge and views about depression and seeking help for depression. Results from a qualitative study on Mexican American adolescents' attitudes about depression are investigated in this paper. Sixty-five high school and middle school students in a largely Mexican American, urban school district in San Antonio, Tex, participated in 9 semistructured, focus group interviews where participants were asked questions to elicit their understanding of depression, treatment for depression, and words used to describe it. Coding of salient words and themes from transcribed interviews were entered into Atlas. ti for qualitative analysis. Three themes emerged: (1) adolescents' definitions of depression, (2) beliefs about adolescent depression, and (3) treatment for adolescent depression. While depressive symptoms among Mexican American adolescents are common and recognized, resource and treatment knowledge is scarce. An understanding of the beliefs, attitudes, and knowledge of these adolescents can provide crucial information about the content and structure of a universal, school-based, peer-facilitated depression awareness program.

Cancer risk factors among men of diverse Hispanic or Latino origins.

BACKGROUND: Personal health behaviors play a fundamental role in premature cancer morbidity and mortality. However, routine risk factor data on Latino groups are lacking. Knowledge of cancer risk prevalence by ethnoregional groups is particularly important for development of effective prevention and control strategies. METHODS: Using the diverse populations and sites involved in the National Hispanic Leadership Initiative on Cancer (NHLIC): En Acción, this paper examines prevalence of six cancer risk factors among Mexican, Puerto Rican, Cuban, and Central American adult males in eight U.S. cities. Data were collected through two telephone surveys. The 1993-1994 sample consisted of 4170 males (2041 <40 years and 2120 > or =40 years). The 1997-1998 sample consisted of 4486 males (2286 <40 years and 2200 > or =40 years). RESULTS: Clear differences exist in risk factor prevalence among Latino subgroups. Overall, riskiest behaviors were found among Mexican American men in Texas, more of whom smoked, engaged in acute alcohol drinking, and had poorer diets and higher obesity levels than other Latino men. CONCLUSIONS: Root causes of these ethnoregional differences are likely due to both economic and cultural factors. Cancer prevention and control strategies and programs should be tailored to address specific needs of each population group.

Seven hundred fifty-three consecutive deaths in a level I trauma center: the argument for injury prevention.

BACKGROUND: The past century has seen improvement in trauma care, with a resulting decrease in therapeutically preventable deaths. We hypothesize that further major reduction in injury mortality will be obtained through injury prevention, rather than improvements in therapy. METHODS: Seven hundred fifty-three deaths in an American College of Surgeons-verified, Level I trauma center were reviewed as they occurred. Deaths were classified as therapeutically not preventable, possibly preventable, or preventable. These charts were also reviewed for factors that might have prevented or lessened the severity of the injury. RESULTS: Mean age was 43, mean Glasgow Coma Scale score was 5, mean Revised Trauma Score was 4, mean Injury Severity Score was 41, and mean probability of survival was 0.25 (according to TRISS). Forty-six percent underwent cardiopulmonary resuscitation in the field, 52% died within 12 hours, 74% died within 48 hours, and 86% died within 7 days. Primary causes of death included central nervous system injury in 51%, irreversible shock in 21%, multiple injuries (shock plus central nervous system injury) in 9%, multiple organ failure/sepsis and other causes in 3%, and pulmonary embolus in 0.1%. Seven hundred one (93%) were classified as not preventable with a change in therapy, 32 (4.2%) were classified as potentially preventable with a change in therapy, and 20 were classified as preventable with a change in therapy (2.6%). Forty-six percent had cardiopulmonary resuscitation performed before or immediately on arrival to the hospital. Another 23% had vital signs present on arrival, but had a Glasgow Coma Scale score of

Predictors of digital rectal examination in U.S. Latinos.

BACKGROUND: Little is known about prostate and colorectal cancer knowledge, attitudes, and screening practices among U.S. Latino men. Even less is known about the population's subgroup variations. This study assessed predictors of having obtained digital rectal examinations (DREs) among four Latino subgroups. METHODS: Findings in this report are based on a cross-sectional telephone survey conducted between October 1993 and June 1994 as part of a multisite demonstration project for cancer prevention and control. The survey was conducted in eight U.S. cities identified via census data as having relatively high concentrations of targeted Latino subgroups. The analysis included 1499 Latino men aged > or = 40 who self-identified as Central American, Cuban American, Mexican American, or Puerto Rican. RESULTS: Overall, 53% of the sample reported ever having had a DRE and 68% reported ever having heard of the procedure. For all subgroups, the only significant predictor for obtaining a DRE was "ever heard of DRE." "Having your doctor discuss DRE" was a significant factor for Mexican Americans and Puerto Ricans. CONCLUSIONS: The lack of a universal DRE cancer-screening model among Latino groups highlights the need to address barriers in the context of the population's diversity. Ecologic approaches and clinician communication with Latinos need to be tailored to accommodate subgroup differences in knowledge, attitude, and practices related to DRE.